The purpose of the Small Employer Health Insurance Availability Act is to promote the availability of health insurance coverage to small employers regardless of the health status or claims experience of their employees.

Under the Small Employer Health Insurance Availability Act, any eligible small employer who wishes to have group health insurance coverage for its employees, regardless of the health conditions in that employer group, can obtain health insurance coverage.

The Health Insurance Portability and Availability Act of 1996 (HIPAA) required that all products in the small employer market issued or renewed after July 1, 1997, must be guaranteed to be issued to a small employer group, regardless of the health status of its members.

If you do not enroll in the small employer group health insurance plan when you are first eligible, and decide to get the coverage later, then you will be considered a late enrollee.

In some instances, an employee may waive coverage under a small employer group, because he has other coverage. If that coverage is later lost, then that employee will not be considered a late enrollee if all of the following requirements are met:

The employee was covered by qualified previous coverage at the time he waived initial enrollment in the employer’s group plan.

The employee lost that qualified previous coverage as the result of termination of employment or eligibility, the involuntary termination of qualifying previous coverage, death of a spouse, or divorce.

The employee requests enrollment in the employer group health plan within 30 days of the termination of the qualifying previous coverage.

Yes. However, if you were previously covered under a creditable coverage and there was less than a 63 day break in coverage, then waiting periods met under the creditable coverage will be credited toward satisfying the pre-existing waiting periods under your new group policy.

No. Each insurer can determine its rates for a group based on the claims experience for all small employers insured by that insurer.

Your rate for your guaranteed issue policy can be affected by several factors, including: age, gender, geographic area, industry, and family composition. In addition, your group, not one individual, can be charged more due to the health conditions of members of the group.

Prior to June 10, 1997, premium rates in the small employer group market were based on a modified community rating. With the change in legislation on June 10, 1997, a carrier in the small employer market is allowed to charge no more than 25% over the index rate for a small employer group with health conditions.

No. An employer cannot “classify” employees. Eligible employees are defined as: employees of a single employer, the officers, managers, and employees of the employer and of subsidiary or affiliated corporations of a corporate employer and the individual proprietors, partners; and employees of individuals and firms the business of which is controlled by the insured employer through stock ownership, contract, or otherwise, who:

Your agent should be able to answer your questions for you. If not, then please feel free to contact the Consumer Services Division of the South Carolina Department of Insurance in Columbia at 803-737-6180 or 1-800-768-3467. You may also write to the department at:P.O. Box 100105Columbia, SC 29202